Intercontinental teleradiology is a newly implemented operational environment for the Medical Diagnostic Imaging Support (MDIS) system project, with phased teleradiology implementation at five sites coming on-line on the Korean peninsula, and four sites being phased in on the island of Oahu, Hawaii, between September 1993 and November 1994. Early implementation and testing efforts began between McConnell Air Force Base, Kansas, and the MDIS Project Office, Fort Detrick, Maryland, in the Summer of 1993. Emphasis is on explaining lessons learned and technical considerations for improving patient care on a global basis. Data on system speed, reliability, image quality, image interpretation and report turn-around is presented. The discussion will cover lessons learned on setting up an intercontinental teleradiology system and various configuration requirements for global teleradiological imaging, diagnosis, and reporting. The scope of the MDIS teleradiology implementation includes U.S. based Picture Archival Communications Systems at major medical treatment facilities which will do consultative and primary diagnostic reading of radiological images sent to them from smaller facilities all over the world.